Behavioral Management for Dementia Caregivers

Rudolph C. Hatfield, PhD., edited by Kathryn Patricelli, MA

The term behavioral management refers to the use of techniques from the behavioral school of psychology to shape a person's actions. People with dementia often do not respond well to explanations and criticism. Instead, they simply respond to environmental changes that can increase the chances that they will respond or act in a certain way. Behavioral management techniques can be used to address many different situations including problems with aggression, wandering behaviors, and getting people to perform positive behaviors. However, it is not a magical technique that works by itself. Caregivers often must put in quite a bit of effort and be consistent.

Most behavioral management techniques are based on the classic notion of the A-B-C method of behavioral management. This method is based on behavioral psychology principles that were used to teach animals and even people to learn new skills by concentrating on specific aspects of their environment. A large amount of research has shown that the A-B-C method can be used to deal with a wide variety of behavior problems that occur in people with dementia. The method can be used to get them to perform actions that are desirable.

The A-B-C Behavior Chain

The A-B-C Behavior Chain can be used to track and analyze challenging behaviors to develop new ways to approach and respond to them. There are three components in the A-B-C Behavior Chain:

A = Antecedent: Antecedents are events or conditions that are present before a behavior occurs. These conditions "set the stage" for a behavior to happen. Antecedents can be:

internal - inside the person such as thoughts or physical sensations occurring within the person with dementia. Examples could include hunger, pain, frustration at not being able to communicate, and many others.

external - outside the person which would include environmental conditions. Some Examples could include loud noises, the temperature in one's room, a busy environment, unfamiliar surroundings, or overwhelming tasks.

B = Behavior: The behavior is obviously the action itself that one is observing or trying to change. These behaviors can be very specific such as types of aggression (hitting someone) or they can be very general (for example, someone is anxious or agitated in many different situations).

C = Consequence: The consequences of the behavior are the events that occur immediately after the behavior has taken place. Consequences can increase the chances or can decrease the chances that the person will repeat the behavior. You can set up consequences for outcomes that you wish to have happen more often. For example:

If you wish to increase a certain behavior you use reinforcement. This is anything that occurs after the person performs a behavior that increases the chances that the person will perform that behavior again. Often these are rewards, but may not always be.

If you want to decrease some behavior you use some form of punishment., This is any event that occurs after the behavior that reduces the chances that the person will repeat the behavior. Punishments do not need to be harsh. They just need to stop the person from repeating the behavior.

The preferred approach is to reinforce behaviors that you want to be repeated instead of trying to punish behaviors. Behavioral management programs typically try and set up conditions where a person is rewarded for producing positive behaviors. Punishments should be used sparingly.